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DocuSign Envelope ID: ED6C5D54-7108-4169-9541-C2FDA3EC8CA6 t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> - Various Chapel Hill, Carrboro, offices, <br /> - Volunteer Center of Durham <br /> We invite any other social agencies that desire training or consulting concerning <br /> implementation of the ADA and customer services to people with disabilities. <br /> We publish a bi annual newsletter and post all events in print and electronic <br /> media to the OCDAC website. www.triangledac.org is a major social media <br /> source, linking us to organizations such as the NC Housing Coalition and New <br /> Hope Project, OPC Mental Health, NC Central Food Bank and Triangle Transit. <br /> We have undertaken collaborative projects in housing for persons with <br /> disabilities with Housing and Human Rights and the Center for Economic Justice <br /> in Raleigh. We have an ongoing collaborative relationship with UNC Apples, A <br /> Helping Hand and Chapel Hill High School - Service Learning and the NC Works <br /> Center. We have and plan to expand the use of volunteer UNC-Chapel Hill <br /> students and hopefully students from other area colleges. We are also <br /> continuing to work on developing a cooperative program with North Carolina <br /> Services for the Blind. <br /> h) Describe what would happen if requested funding is not awarded at all or if a reduced <br /> allocation is recommended. <br /> • Services for people will low to no income would be charged for the services that <br /> TDAC provides and many people would go without. Workload for our partner <br /> agencies would increase and general knowledge and understanding about <br /> social services would be diminished. TDAC provides necessary resources to its <br /> clients that would otherwise not be provided the assistance that they need. <br /> i) Include any other pertinent information. <br /> • It is crucial with the increase of requests for immediate housing to avoid <br /> homelessness by people with disabilities; that we are funded for paid half-time <br /> staff. Note: the cost for services and/or rental is $500.00 to 1,500 e.g. assistive <br /> listening devices, interpreters. <br /> Program/Project Information <br /> j) Complete the Target Population and Program Beneficiary Demographics Chart <br /> k) Complete the Schedule of Positions Chart for Program Staff <br /> I) Disclosure of Potential Conflicts of Interested must be signed <br /> m) Complete the Work Statement Chart to describe the work to be performed, and be sure to <br /> attach copies of all data collection tools that will be used to verify achievement of program <br /> goals and objectives. Describe who will be responsible for monitoring progress. <br /> Information to Complete <br /> j.) Target Population <br /> Complete the following tables to the best of your ability. Show numbers of participants and <br /> percentages, as applicable, in each category. <br /> Please indicate whether this project/program will serve: ❑ Persons ❑ Households ❑ Units <br /> Main Application 5/25/2016 9:25:11 AM Pag of 20 <br />